Carol Severson is an Oregon midwife facing a terrible and unjust challenge!

Here is Carol's story, in her own words:

I will be in court on June 24, 2004 at 1:30 pm to plead "NOT GUILTY" to a charge brought against me by the District Attorney of Marion County of "Criminal Mistreatment in the 2nd degree".

For those of you have not heard what is happening, on January 31,2001, I delivered a baby with a moderate dystocia and cord around the neck 2 times. Apgars were 3, 7, 9. Baby responded well with our initial efforts of bag and mask.. It was apparent after some time that this baby needed more help, so we transported to the nearby hospital. Baby responded well.

SOMEONE called Salem police, an investigation was made and mistake # 1 (even if you are innocent, NEVER talk to police without an attorney present!). Then on April 16, I was contacted by a investigator who wanted to ask me questions, (Bigger mistake NEVER, NEVER, talk to an investigator without an attorney present!!) but, having nothing to hide, I talked to him. By the way BABY is FINE and parents know nothing of what is going on, to my knowledge. (Mom of baby called the following day to ask me question about birth certificate and tell me the baby had been to the Ped for check up and was doing really good, in the 90th percentile).

The investigation went poorly, he made me feel like a fool, scoffed at me. That was one of the worst days of my life. No "rights" were read to me because he wasn't arresting me, that day. The following week I was given the choice of coming and picking up my citation and being booked(finger prints and all) or them coming out hand cuffing me and taking me to the jail where they would do it.

This can happen to anyone of us, even if the baby if fine. Without a trial this has already cost me close to $4000, and if it goes to trial, ???? $10,000+

I represent all midwives in Oregon and I am going to do my best. I followed my guidelines as a licensed midwife!

The piece of paper given me in the Circuit Court says that I "having assumed the care, custody and responsibility for the supervision of........., did unlawfully and with criminal negligence withhold necessary and adequate medical attention". If I had called 911 maybe I wouldn't be dealing with this issue.

Yes it has been hard for me, I have never been involved with the law, don't know the process. I dismissed my first attorney because he told me he "loved to go to trial" and after the fourth meeting I decided it would be in my best interest to find an attorney that would try to keep this from going to trial, since that baby is fine. First attorney also said I needed to take out a loan for $15,000 and at that it was still going to cost me more.

I know there is a reason for all of this, if nothing more than a "wake up call" to ALL midwives. If this goes to trial I will let everyone know. Those of you who have the time and want to attend Thursday court are welcome. It will be short, I just plead "not guilty" and a trial date will be set. My new attorney is going to meet with the mother of the baby and see if she will sign an affidavit to get this dropped. Then it will be left up to the court for them to decide if they still want to go to trial. If she signs, this would be an important time for all of you who can come to support midwifery and be there the day it goes to the court to be determined trial or be dropped.

NOTE FROM GAIL:

Every midwife, every student, every apprentice, every homebirth family should rally around Carol. Any of us can find ourselves in a similar situation. Following the rules, obeying all the guidelines, is not a guaranteed protection against an unjust legal attack.

This is an attack against ALL midwives, against Homebirth, and against Midwifery! Support Carol as she fights this charge! Help protect Midwifery!

HOW TO HELP CAROL:

COME TO THE COURT HEARING!

Date: June 24, 2004Time: 1:30 PM Place: 4000 Aumsville Hwy, Salem OR

HELP WITH FINANCES!

(Think how we would feel if WE were the midwife facing this! Wouldn't we hope for help from our sister midwives?)

THE FASTEST AND MOST EFFECIENT WAY TO FUNDRAISE IS TO OPEN OUR OWN CHECKBOOKS! Even if only fifty of us contribute $50 each, Carol will be able to pay $2500 of her attorney fees! Some of us may be able to contribute more and others less, but let's each send every dollar we can! Helping with attorney fees is the best way we can show our support.......and

UPDATES
had an emergency u/s friday, so missed the omc meeting. I just posted the notice for next months meeting. Guests, please REMEMBER TO CHECK THE "WORKSHOPS, CLASSES, CONFERENCES" entry whenever you are here!

hve been busy with conference details; mailed out the flyers yesterday. It's a big job printing, folding, inserting, stamping a mailing of that size, but is' also kind of like relaxing -- very zen.we're entering the exciting time -- have finished the lead-up jobs. Now we wait on registrations to arrive.We've got a great lineup of speakers and a cool confernc location. i think it's gonna be a lot of fun!

special notice OMC meeting
I just got an email announcement today about the OMC regional meeting this friday. I just posted it here and on "midwifery updates". This is an important meeting and everyone should come if possible (I'll be there if not at a birth!)

i posted some new info on our Spring Conference. Readers, please be sure to check there frequently. As we become more busy with organizing, i might not have time to update this site.

Doing some updates
wow, I hadn't realized how much has happened since i last updated midwife muse. I deleted many announcements of meetings long past and added new ones under the 'conferences and workshops" title. Please keep sending me your announcements -- or post them yourselves under 'post a comment" - and i will try to keep things current.

Just a note: the Karen Strange Resuscitations classes were GREAT! Many midwives commented that the classes helped them understand the principles of NNR in a new way, and they are very excited to put their new knowlege to use (well, sort of, since no one every 'wants" to have to do resuscitation!).

We're busy setting up the next Midwifery Updates Conference -- addressing envelopes, contacting teachers, working out recipes, preparing our own classes. It's a whole lot of work, but a whole lot of fun too. This is our first two-day event and some logistics get pretty complex.

The work goes by faster now that I have a radio station worth listening to. I love public radio of course, but now we have something even better -- still "educational" but more entertaining and much funnier than public radio. "Air America" is on AM 620 here in portland (and can be heard over the web for those out of range). I addressed and stuffed a hundred and fifty envelopes this afternoon and hardly noticed it because of the great hosts on that station! Finally, an AM talk show worth listening to!

I'll be posting here more frequently since i'll be at the computer so much anyway gathering online registrations and working on the various projects which need to be done before the conference.

My family has learned to be patient with me in the early weeks of planning. I'm always a nervous wreck until enough registrations come in to cover the advance financial outlay! (I just wrote out the deposit check for the facility today. I sure hope y'all are going to come!) The kids remind me that we've always had plenty of attendees -- often more than we could comfortabley hold -- and I'm sure this conference will be the same. But i'm always on tenterhooks until that twentieth registration comes in!

The meeting room for this conference holds a maximum of 45. Having a smaller number will make some things easier than past conferences where we had 80 or more!

I think i've done enough today. I set up the online registration forms as well as the webpage (midwiferyeducation.org) and updated this blog too. I'm gonna go to bed! And hope the woman due april 15 doesn't decide to go into labor tonight.......I would love to have a full night's sleep!

WORKSHOPS, CLASSES, CONFERENCES in the Northwest!
I've been posting things as they arrive. This topic line will be kept open for announcements. Anyone can easily add additional ones by "posting a comment"!

Here's the current list for events in the next three months -- and i'll try to KEEP things current by deleting events after they expire. (note-- These are condensed versions of the announcements. To read more information, contact the presenters, or go to www.midwiferyeducation.org to read the full announcements.)

Also --- I'm THRILLED to announce the date for our next MIDWIFERY UPDATES SPRING CONFERENCE MAY 24, AND MAY 25! We're also hosting a CPR certification/recertification class! Pease SEE OUR website for more information. I've posted some of the details below.

NORTHWEST CONFERENCES AND CLASSES

OREGON MIDWIFERY COUNCIL QUARTERLY MEETING The next OMC meeting in Eugene is scheduled for May 21st. Nominations will be accepted for President, Secretary/Treasurer and Newsletter Editor. If you cannot come contact Lisa Lehrer lisa_lehrer@yahoo.com (check OMC website for more details)

We have a wonderful conference venue - the Manor House at Leach Botanical Gardens -- a truly magnificent, intimate, garden setting. But enrollment is ABSOLUTELY LIMETTED to forty participants, and you must register as soon as possible to reserve your place!

Do you need your yearly CPR Certification or Re-certification? We're hosting a CPR class Tuesday afternoon for the moderate price of $45 (which includes your lunch!)

KAREN STRANGE RESUSCITATION CLASS
Karen has decided to add a THIRD OREGON CLASS in Neonatal Resuscitation For Midwives! There will be an additional class on Wednesday in Portland. See midwiferyeducation.org for details -- or contact kate mclachlan kkmcl@yahoo.com to learn more or to sign up!

Karen will also be holding a class in Belleview Washington on February 1st. Contact Heather Shelley for details: Phone: 425-401-8643 or 425-246-2097 cell

meconium -- suctioning - bulb versus delee
Several centuries ago, the early midwifery and OB books said that a baby born with thick meconium might be in trouble -- especialy if it was small, or if the labor had been difficult, or if the baby's heart had been slow or erractic during labor. If meconium is light -- what the old books called "coloured waters" - the baby rarely showed any effects. After all these centuries it seems we haven't added much new to this. We have made great progress in the last twenty years in TREATING babies with Meconium Aspiration Syndrom (MAS), and what about prevention? We've developed many new suctioning methods, but do they succesfully prevent MAS?

Here a large study out of Singapore confirming the old knowlege -- that Meconium Stained Amniotic FLuid (MSAF)is not uncommon, yet MAS is rare without the combination of thick meconium and poor Fetal Heart Tones. They found the incidence of MAS with light meconium staining was 0.3%, with moderate it was 5.8%,and thick was 61% -- and that poor heart-tones were a deciding factor. This study had nearly 2000 MSAF babies, and that 3out of a thousand number (for light mec) is rather reasuring, considering the incidence of meconium staining reportedly ranges from about 15% to 28%.

That "range" is interesting, and some study locations report a much higher range than others. Just annecdotally, most midwives see a much lower incidence of MSAF (of course we deal primarily with low risk pregnancies), but many of us have wondered if the rate is increasing. Seems it just might be according to this large 1991 hospital study which concluded "the incidence of meconium-stained amniotic fluid increased 40.9% over the study period, from 18.8% in 1980 to 26.5% in 1986". They give no guess of "Why".....but i personally wonder if the advent of EFM (with supine maternal position) and epidurals might be a factor. Or maybe the rise in rate of induction? Or augmentation? It wasn't all THAT many years ago that pitocin was a rarely used drug -- now it's almost a routine thing.

But, what should we do if MSAF occurs (assuming heart tones are reasuring)? Do we suction? And when? On the perinuem? After delivery, but before the first breath? ANd what do we use if we ARE going to suction? Some midwives are criticised if they use an old-fashioned bulb syrnge instead of a delee suction tube. Is a delee trap any better -- more effective -- than a bulb syrnge or suction tube? The DeLee was adopted without good study. It turns out that a bulb syrnge is probably BETTER than a DeLee, and this study concludes "We recommend the use of bulb suction as routine obstetric practice even in the presence of thick meconium." This one also calls a bulb syrnge the "preferable method" since it is as effective, less expensive, easier to use and safer, than a DeLee.

But does it make any difference if we suction, or when, or with which device? Here is one of many large studies concluding that MAS develops long before we ever see the baby:"oronasopharyngeal DeLee suctioning at the perineum does not affect the rate of meconium aspiration syndrome. We speculate that meconium aspiration syndrome is predominantly an intrauterine event associated with fetal distress and that meconium in the airways is merely a "marker" of previous fetal hypoxia."

Meconium Aspiration is non-preventable. No matter who attends the birth, no matter where the baby is born and no matter which suctioning method (if any)is used. It occurs within the womb, not on the perineum. It is not predictable. Our only clue may be an poor heart rate pattern. In effect, our oldest textbooks are still accurate. We've made progress is "treating" MAS, but not in "preventing" it.

Worried about a big baby? Thinking you might need to induce? WOnder what ACOG thinks about inducing to prevent macrosmia? Here's the dope on that sticky subject.

It almost seems to be some sort of secret that ACOG does NOT advise elective induction or ceserean for big babies. In thier "practice guidline" they reason that diagnosis of fetal macrosomia is imprecise, and that ultrasound is no more accurate than palpation or external estimates, and that induction isn't warranted since it doesn't improve fetal or maternal outcome.As long as mom doesn't have diabetes -- and baby is expected under 5 kg (11 pounds)-- then a spontaneous vaginal delivery "is not contra-indicated". But read it yourself.

Here's an intersting site. Ever hear of Mayan Massage? It's one of those old folk wisdoms, and seems pretty neat!

Well,ok, this one is a political link and not related to midwifery link. But it's still pretty cool!

CORD CARE
What do you do -- or don't do -- for umbillical cords?Do you put anything on them? Forbid baths? How long do you leave the clamps on? Do you clamp or not? What type of ties/clamps do you use?

I'll start with what "I"do, just to get the ball rolling. (I think it's great to discuss different ideas)

i don't put ANYTHING on cords -- not even alcohol -- although if parents insist on it, I don't forbid it.

I also recomend tub baths from birth onward. It seems to help the cords fall off quickly, limits any foul smell, and doesn't raise the risk of infection(probably actually lowers it).